The Prevalence Of Celiac Diseae Among Patients With Irritable Bowel Syndrome

BackgroundCeliac disease,also known as gluten-sensitive enteropathy or celiac sprue,is a chronic inflammatory enteropathy characterized by flattened villi on the small bowel mucosa in genetically predisposed people(carring the HLA-DQ2or-DQ8genotype).It is triggered by the ingestion of gluten-containing foods,enhanced by other environmental cofactors.Traditionally,celiac disease is considered as a malabsorption syndrome,however,with the widespread availability of serological tests and the development of endoscopy,it more closely resembles a multisystemic disorder,untreated celiac disease increases both mortality and intestinal lymphomaWith prevalence ranges from0.2%to2.7%by serologic testing and0.2%～1.9%by biopsy,it is now accepted that CD is common throughout the world.In the past decades,as "new" symptoms and CD-associated extraintestinal manifestations were recognized.the prevalence and incidence has a marked increase.However,the prevalence of CD prsents as "celiac iceberg",most cases are still remained undiagnosed,leaving those patients exposed to the long-term complications,such as,enteropathy associated T-cell lymphoma(EATL),infertility and axonal neuropathy.Until now,there is no systematic studies on the prevalence of CD in China have been reported. Irritable bowel syndrome(IBS) is one of the most common functional bowel disorders encountered in gastroenterology practice.Currently,the diagnosis of IBS bases on ROMEⅢ criteria developed by a multinational consesus.IBS has a similar gastrointestinal symptom spectrum of celiac disease.According to previous published study.the prevalence of CD among IBS patients is7-fold of general people.ObjectiveWe evaluated the serologic based prevalence of CD in the outpatients fulling ROME III criteria of IBS that attended Gastroenterology Cline of Qilu Hospital of Shandong University by using the specific tTG-IgA(anti-tissue transglutaminase IgA)MethodsThis is a single center.prospective chort study.A study population fulling ROME Ⅲ diagnostic criteria for IBS were enrolled between Augst2012and March2013.Patients with alarming features,family history of a first-degree relative with colon cancer and inflammatory bowel discase,abnormal physical evaluation finding or laboratory signs or lower endoscopic examination were excluded.After explaining the aims of the study and the possible necessity for upper con focal laser endomicroscopy and duodenal biopsies.all patients provided written informed consent.Then a5ml blood sample was drawn from each patient,we measured tTG-IgA by a commerical available enzyme-linked immunosorbent assay kit.Results126patients were enrolled in the study.with60(48%) were male. The mean age of the study population was45.45±12.467(19-73)years old.while the mean duration is6.375±8.877(6months to40years) years. At the end of the study,10(7.94%) patients with abnormal tTG-IgA were detected.among which3participants underwent con focal laser endoscopy and small intestianl biopsy at the time of the enrollment,and the histopathology were confirmed the diagnosis. Another2patients had a level of tTG-IgA over10-fold of the cutoff value(12U/ml). ConclusionsOur preliminary study results illustrustrates that7.94%of our enrolled IBS patients with evaluated tTG-IgA level.So we hypothesize that CD may be not rare in China,but just because we didn’t pay much attention on it.Later,a larger sample,multicenter,even population-based epidemiology should be conducted.